As part of an update to the EMS rules, the Board has removed fee waivers for EMS satellite locations (see rule 4729:5-14-02 and the rescission of rule 4729-33-02). The proposed effective date of this rule was to occur during the 2018 terminal distributor renewal cycle.

Please be advised that the Board has postponed the implementation of this rule change until April 2, 2018. This means that the fee waiver for EMS satellite licenses will be effective for the 2018 terminal distributor renewal cycle.

Those who have already renewed an EMS satellite license may request a refund by submitting a request (please include name of organization, address of the licensed location, license number and a contact name and phone number) tolicensing@pharmacy.ohio.gov. Refund requests will be honored untilApril 2, 2018. Refunds may take up to six weeks to process.

IMPORTANT: Effective April 2, 2018, an application for a new satellite location will be assessed a fee and all future renewals of EMS satellite licenses will also incur a renewal fee.

This e-mail may contain sensitive law enforcement and/or privileged information. If you are not the intended recipient (or have received this e-mail in error) please notify the sender and destroy this e-mail. Any unauthorized copying, disclosure or distribution of the material in this e-mail is strictly forbidden. This message and any response to it may constitute a public record and thus may be publicly available to anyone who requests it.

Ketamine is in severe shortage and is not able to be replaced in the drug bags so please start checking as you exchange bags to see if there is Ketamine in the bag or not. I have asked the pharmacists to use the luggage tags to show if the bag is missing Ketamine. Please email me with any questions. bpdeere@premierhealth.com. Thanks Brendan

We have had some departments that have been inspected by the Board of Pharmacy and one of the requirements is to have a signed version of the protocol by your medical director that is notarized. You can make your own document that the medical director signs it just needs to have the wording that the medical director approves the use of the 2018 protocols. You must also have a copy to the protocol with that form.

Please see the attached flyer for our upcoming Pre-Hospital Trauma Life Support provider course held at Kettering College’s state of the art simulation center.

Ryan Konkel, BS, NRP

EMS Coordinator, Emergency Medical Services

Kettering Health Network

O.(937)-395-6110 x56110

C.(937)-305-7817

F.(937)-522-8477

**KHN Confidentiality Notice** This email may contain legally privileged and confidential information from Kettering Health Network intended only for the individual or entity named above as the intended recipient. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or copying of this communication is prohibited. If you received this communication in error, please notify us by email and promptly delete the original message.

Regarding the recommendation from the Ohio Department of Health to administer Narcan (naloxone) in "drug overdoses when non-opiates are suspected/indicated", I concur with EMS Council that EMS providers must follow their standing orders, online medical direction, or specific written supplemental standing orders from their EMS Medical Director.

The administration of Narcan is not completely benign, particularly in a mixed overdose involving a stimulant. Reversing opiates can potentially unmask or worsen symptoms of stimulant overdose leading to first responder injuries, worse patient outcomes, or even fatalities. This has been observed in this region. Therefore, I would again strongly urge following the current Standing Orders for administration of Narcan.

Also, please be aware that in the event of a patient becoming combative after the administration of Narcan, use of ketamine and/or Versed (midazolam) maybe indicated. Rapid chemical control in these circumstances may help to prevent complications such as hyperthermia and lactic acidosis that can lead to sudden cardiac death.

Questions should be addressed to your Medical Director, the Regional Physcians Advisory Board (RPAB), or to myself. I would be happy to answer any questions or address any concerns on this or any other topic.

**This is an advisory message from the Ohio Department of Health. It does not replace EMS medical direction. EMS personnel should continue to follow Standing Orders in all overdose cases.**

Health Advisory

Continuing Increase in Fentanyl-Related Overdose Deaths Involving

Non-Opioids Like Cocaine, Methamphetamines/Other Psychostimulants

Administer naloxone for drug overdoses even when non-opioids indicated

Preliminary 2017 data shows a continuing increase in fentanyl-related drug overdose deaths, including an increase in overdose deaths involving both cocaine and fentanyl, as well as methamphetamines/other psychostimulants and fentanyl.

Preliminary 2017 data indicates that 71% of all unintentional drug overdose deaths involved fentanyl or a fentanyl analogue. By comparison, 58% of overdose deaths did so in 2016, 37.9% in 2015, 19.9% in 2014, and 4 percent in 2013.

Preliminary 2017 data indicates that in 22% (850) of all overdose deaths, cocaine and fentanyl or its analogues were both mentioned on the death certificate, compared to 15% (619) in 2016 and 8% (239) in 2015. Additionally, overdose deaths in which both fentanyl and methamphetamines/other psychostimulants were mentioned on the death certificate increased 142% from 2016 (117) to 2017 (283).

People who use illicit drugs and who are not familiar with the risks, such as those who use cocaine occasionally, are at exceptionally high risk of an overdose when using cocaine mixed with fentanyl.

Fentanyl is a schedule II synthetic painkiller approved for treating severe pain, typically advanced cancer pain. It is 30 to 50 times more potent than heroin. However, most cases of fentanyl-related harm, overdose, and death in the U.S. are linked to illegally manufactured fentanyl. Fentanyl is often mixed with heroin and/or cocaine as a combination product—with or without the user's knowledge—to increase its euphoric effects.

Recommendations

Because of the increase in overdose deaths involving cocaine and fentanyl, and methamphetamines and fentanyl, the Ohio Department of Health is making several recommendations to first-responders, healthcare providers, substance abuse treatment professionals, community-based Project DAWN (Deaths Avoided With Naloxone) programs, and others who interact with people who use illicit drugs.

Administer Naloxone in Drug Overdoses When Non-Opioids are Suspected/Indicated

Even though naloxone is not effective in treating drug overdoses caused solely by stimulants such as cocaine and methamphetamines, the administration of naloxone may be helpful in drug overdoses caused by a combination of stimulants and opioids like fentanyl and its analogues.

Help Educate Individuals About Dangers of Illicit Drugs Potentially Mixed With Fentanyl

Educate patients/clients who use illicit substances about the dangers of illicit drugs like cocaine and methamphetamines being mixed with fentanyl and the increased risk of overdose and death. Key points to emphasize include:

Fentanyl is often mixed with other drugs without the user's knowledge.

Fentanyl is more likely to be fatal due to its high potency and how long it stays in the body.

Do not use drugs while alone so that someone else can help/get help for them if they overdose.

Make sure that the drug user, their family and friends all have been trained on the signs and symptoms of a drug overdose, where to get naloxone and how to administer it, how to do rescue breathing, and the importance of calling 911 immediately even when naloxone is administered.

Do not leave the ambulance or hospital against medical advice after naloxone has been administered to reverse the overdose. The naloxone may wear off before the opioids wear off – and you could go into overdose again.

Help Individuals Get Access to Naloxone

Encourage patients/clients who use illicit drugs, as well as their family and friends, to carry naloxone. Refer them to a local Project DAWN community-based naloxone education and distribution program, or refer them to a local pharmacy that dispenses naloxone. More information about where to obtain naloxone is available at http://www.odh.ohio.gov/odhprograms/naloxone/stopoverdoses.aspx.

Fentanyl is an opioid analgesic. The biological effects of fentanyl are indistinguishable from those of heroin. Treatment is the same as for other opioid overdose, however, larger than usual doses of naloxone (2-10mg) and/or multiple administrations of naloxone might be required for reversal of the opioid effects. Fentanyl is not detected by standard urine opioid immunoassays; therefore, opioid exposure should not be ruled out based on toxicology screen results. Consult your laboratory for preferred testing methods. Symptoms of overdose are characteristic of central nervous system depression: lethargy, respiratory depression, pinpoint pupils, change in consciousness, seizure, and/or coma.

Don’t miss the opportunity to see multiple nationally known speakers at the 2nd Annual EMS Symposium & Trauma and Critical Care Update!

Additional details to come.

See you there!

Elizabeth Evans

EMS Coordinator

Miami Valley South & Miami Valley Jamestown

Phone: 937-438-4438

Fax: 937-223-9314

This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this email in error please notify the system manager. This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received this e-mail by mistake and delete this e-mail from your system. If you are not the intended recipient you are notified that disclosing, copying, distributing or taking any action in reliance on the contents of this information is strictly prohibited.

For the 2018 Drug License Renewal please just use the license information from 2017. Please make sure to add the Solumedrol and Plasmalyte. I know we did this last year but since the BOP does not send back the drug list we are doing this just to make sure it is on the list. We have attached the letter from last year again as reference. If there are any questions please email me at bpdeere@premierhealth.com

******PLEASE NOTE THE COST OF THE LICENSE IS $220.00 PER STATION.****************************

**This is an advisory message from the Ohio Department of Health. It does not replace EMS medical direction. EMS personnel should continue to follow Standing Orders in all overdose cases.**

Health Advisory

Continuing Increase in Fentanyl-Related Overdose Deaths Involving

Non-Opioids Like Cocaine, Methamphetamines/Other Psychostimulants

Administer naloxone for drug overdoses even when non-opioids indicated

Preliminary 2017 data shows a continuing increase in fentanyl-related drug overdose deaths, including an increase in overdose deaths involving both cocaine and fentanyl, as well as methamphetamines/other psychostimulants and fentanyl.

Preliminary 2017 data indicates that 71% of all unintentional drug overdose deaths involved fentanyl or a fentanyl analogue. By comparison, 58% of overdose deaths did so in 2016, 37.9% in 2015, 19.9% in 2014, and 4 percent in 2013.

Preliminary 2017 data indicates that in 22% (850) of all overdose deaths, cocaine and fentanyl or its analogues were both mentioned on the death certificate, compared to 15% (619) in 2016 and 8% (239) in 2015. Additionally, overdose deaths in which both fentanyl and methamphetamines/other psychostimulants were mentioned on the death certificate increased 142% from 2016 (117) to 2017 (283).

People who use illicit drugs and who are not familiar with the risks, such as those who use cocaine occasionally, are at exceptionally high risk of an overdose when using cocaine mixed with fentanyl.

Fentanyl is a schedule II synthetic painkiller approved for treating severe pain, typically advanced cancer pain. It is 30 to 50 times more potent than heroin. However, most cases of fentanyl-related harm, overdose, and death in the U.S. are linked to illegally manufactured fentanyl. Fentanyl is often mixed with heroin and/or cocaine as a combination product—with or without the user's knowledge—to increase its euphoric effects.

Recommendations

Because of the increase in overdose deaths involving cocaine and fentanyl, and methamphetamines and fentanyl, the Ohio Department of Health is making several recommendations to first-responders, healthcare providers, substance abuse treatment professionals, community-based Project DAWN (Deaths Avoided With Naloxone) programs, and others who interact with people who use illicit drugs.

Administer Naloxone in Drug Overdoses When Non-Opioids are Suspected/Indicated

Even though naloxone is not effective in treating drug overdoses caused solely by stimulants such as cocaine and methamphetamines, the administration of naloxone may be helpful in drug overdoses caused by a combination of stimulants and opioids like fentanyl and its analogues.

Help Educate Individuals About Dangers of Illicit Drugs Potentially Mixed With Fentanyl

Educate patients/clients who use illicit substances about the dangers of illicit drugs like cocaine and methamphetamines being mixed with fentanyl and the increased risk of overdose and death. Key points to emphasize include:

Fentanyl is often mixed with other drugs without the user's knowledge.

Fentanyl is more likely to be fatal due to its high potency and how long it stays in the body.

Do not use drugs while alone so that someone else can help/get help for them if they overdose.

Make sure that the drug user, their family and friends all have been trained on the signs and symptoms of a drug overdose, where to get naloxone and how to administer it, how to do rescue breathing, and the importance of calling 911 immediately even when naloxone is administered.

Do not leave the ambulance or hospital against medical advice after naloxone has been administered to reverse the overdose. The naloxone may wear off before the opioids wear off – and you could go into overdose again.

Help Individuals Get Access to Naloxone

Encourage patients/clients who use illicit drugs, as well as their family and friends, to carry naloxone. Refer them to a local Project DAWN community-based naloxone education and distribution program, or refer them to a local pharmacy that dispenses naloxone. More information about where to obtain naloxone is available at http://www.odh.ohio.gov/odhprograms/naloxone/stopoverdoses.aspx.

Fentanyl is an opioid analgesic. The biological effects of fentanyl are indistinguishable from those of heroin. Treatment is the same as for other opioid overdose, however, larger than usual doses of naloxone (2-10mg) and/or multiple administrations of naloxone might be required for reversal of the opioid effects. Fentanyl is not detected by standard urine opioid immunoassays; therefore, opioid exposure should not be ruled out based on toxicology screen results. Consult your laboratory for preferred testing methods. Symptoms of overdose are characteristic of central nervous system depression: lethargy, respiratory depression, pinpoint pupils, change in consciousness, seizure, and/or coma.

The posting states it closes today, but the deadline has been extended to the end of month.

I will stay in my current position until the current Paramedic Class has finished in August, but we are posting now in hopes of having a transitioning process between myself and the new coordinator. My plan is continue to stay on staff to teach, and assist with various administrative duties after August.

If your department has an old or out of service manual cot that they are looking to get rid of or sell please contact Katie Williams at Franklin Fire. They are in need of one for storage/movement of their new SIM man training manikin. Katie can be reached by email at kwilliams@franklinohio.org.

Soin Medical Center Cath Lab will be replacing their floors next week the 16th through the 19th . This means emergent cath lab intervention will not be available during those three days.

Thanks,

Meredith Lawhorn, BA, Paramedic

EMS Coordinator

Kettering Health Network

c.440-637-3869

f.937-522-7925

**KHN Confidentiality Notice** This email may contain legally privileged and confidential information from Kettering Health Network intended only for the individual or entity named above as the intended recipient. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or copying of this communication is prohibited. If you received this communication in error, please notify us by email and promptly delete the original message.

Can you please forward the attachment to your contact lists? This is the latest Motorola promotion for radio purchasing. If anyone is interested in pricing, I have some base quotes that I can share with them. I did not want to attach them to this email as it could get fairly big.

I am currently researching the topic of diversity for an applied research paper as part of the National Fire Academy’s Executive Officer Program (EFOP). I know that you are all very busy, but if you could take a few moments to complete the short survey below, I would truly appreciate it! I will be using the data gathered for statistical purposes only. The initial question asking for department name is used only to prevent duplication of data. Please feel free to contact me with any questions.

Looking forward to seeing you at our meeting on Tuesday February 6th from 1130-1330 at GDAHA. Lunch will be provided but please RSVP to Sandy at slehrter@gdaha.org so she can get a food count.

I have reached out to the state to get data. Tuesday we will go over our plan for 2018.

Thank you,

Meredith Lawhorn, BA, Paramedic

EMS Coordinator

Kettering Health Network

c.440-637-3869

f.937-522-7925

**KHN Confidentiality Notice** This email may contain legally privileged and confidential information from Kettering Health Network intended only for the individual or entity named above as the intended recipient. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or copying of this communication is prohibited. If you received this communication in error, please notify us by email and promptly delete the original message.

NOTICE: The information contained in this e-mail and any accompanying documents or files is intended for the sole use of the recipient to whom it is addressed, and may contain information that is privileged, confidential, and prohibited from disclosure under applicable law. If you are not the intended recipient, or authorized to receive this on behalf of the recipient, you are hereby notified that any review, use, disclosure, copying, or distribution is prohibited and possibly a violation of federal/state law or regulations. If you received this information in error, please notify Dayton Children's Hospital immediately via telephone at (937) 641-5293, or via electronic mail cmcconfidentiality@childrensdayton.org and promptly destroy the original message. Thank you.

This is a reminder that the 2017 Computer Based Test (CBT) is still available. All department members that have not passed the 2017 CBT cannot operate under the GMVEMSC protocol or use the drug bag until the 2017 CBT is passed. The rules are outlined more clearly in the Implementation Guidelines.

This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this email in error please notify the system manager. This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received this e-mail by mistake and delete this e-mail from your system. If you are not the intended recipient you are notified that disclosing, copying, distributing or taking any action in reliance on the contents of this information is strictly prohibited.